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The goal of this paper is to present a clinical case of a 4 year old boy, with hepatomegaly, splenomegaly and intestinal lipid infiltration due to a inborn error of lipid metabolism known as cholesterol ester storage disease. The main clinical manifestations were hepatomegaly, splenomegaly, hypertriglyceridemia, hypercholesterolemia. Duodenal endoscopy showed a yellow appearance of the mucous, and the histological study revealed the presence of macrophages with granular material. Liver biopsy showed steatosis infiltration at the hepatocytes, and macrophages with lipids. This disease is due to a lisosomal acid lipase partial deficiency, that is a glicoprotein that metabolize the hydrolysis of ester of cholesterol and triglycerides. The name of this pathology is cholesterol ester storage disease, but when the deficiency is total the name is Wolman's disease. We conclude that in all the children whit a clinical picture of hepatomegaly, splenomegaly, hypertriglyceridemia and hypercholesterolemia it is obligatory to rule out an inborn error of lipid metabolism like Wolman's disease or cholesterol ester storage disease.

Peutz-Jeghers syndrome is an autonomic dominant disease characterized by hamartomatous polyps and mucocutaneous hyperpigmentation. We present 16 cases; females were more affected. The most common presenting complaints were of gastrointestinal tract. All polyps found were hamartomatous with general distribution through gastrointestinal tract. Endoscopic polypectomy should be carried out for treatment. Radiologic, endoscopic and histologic studies should be conducted for long-term follow-up, because of high risk of malignancy.

Unlabelled: Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications., Aim: To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery., Method: The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.

Although the Mexican population has traditionally been malnourished, the prevalence of obesity in children and adults has increased by almost 50 % in the last 10 years. Recent studies show substantial changes in the nutritional status of Mexicans, especially in the pediatric population. Among the factors associated with the development of obesity are overeating, sedentariness, and genetics. The apparent economic development in Mexico, as well as the influence of dietary patterns from other countries, have contributed to modifying lifestyle. Despite measures taken by the health system, iron- and zinc-deficiency anemia continue to be prevalent. The present review aims to describe the changes that have taken place in Mexico in the last few decades leading to a generation of short and obese children, as well as to determine the associated factors in order to promote healthier eating patterns among the Mexican population.

Iron-deficiency anemia is still a health problem worldwide. Iron supplementation of some foods such as milk formulas and cereals apparently has not been the solution due to bioavailability of iron. In Mexico, there is high prevalence of anemia in children to date, mainly those under 2 years of age and predominantly in the Southern part of the country. Probably the main causes are iron-deficiency anemia in pregnant women, recurrent infections, such as gastroenteritis and parasites, and the most important one undoubtedly, deficient iron intake.

Background: Juvenile polyposis (JP) is a frequent cause of lower gastrointestinal bleeding. It is present in 3-4% of the population < 21 years of age and represents 90% of all polyps in childhood. The most common complaints are hematoquezia, abdominal pain, and polyp prolapse., Methods: A descriptive, observational, transversal study of 225 children with histopatologic diagnosis of JP seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría, between January 1985 and December 2000. Variables studied included age of presentation, gender, frequency, clinical manifestations, type, location, and diagnostic and therapeutic methods., Results: Frequency was one polyp per 162 patient seen during the same period (0.61%) and age 2 to 8 years (82%), a total of 235 patients, 120 females and 273 total polyps were found rectum the most common site 82% (224 polyps) followed by sigmoid. Mean distance from anal margin was 6.5 cm. Of all polyps, 82.9% were in the first 10 cm of anal margin. Of all patients, 92.3% had a single polyp and 7.7% had multiple polyps. A baritated study was made in 39 patients (16.6%) with diagnostic efficacy of 74%. No additional baritated studies were needed because of high diagnostic and therapeutic efficacy of the rectosigmoidoscopy., Conclusions: Rectosigmoidoscopy and colonoscopy remain as the diagnosis and therapeutic method in children with JP.

Background: Meckel's diverticulum is a well known disease in children. The main clinical presentations are rectal bleeding and intestinal occlusion., Objective: To investigate the frequency, main clinical symptoms, signs, complications, localization, histology and diagnosis in a population of mexican children., Method: We studied 61 children who were seen at the Instituto Nacional de Pediatria, Mexico City, during a period of 10 years. The age, sex, symptoms, complications, hematocrit, 99mTc-Pertechnetate scanning, histology, and localization of Meckel's diverticulum were analyzed in all of them., Results: 15 children were female and 46 male (1:3). In infants the main clinical finding was rectal bleeding. Intestinal occlusion was the most common clinical expression in older children. Gastric mucosa was a common finding in the diverticulum of children with rectal bleeding in contrast to ileal mucosa in children with intestinal occlusion. 99mTc-pertechnetate scanning with previous administration of H2 blocking agent was the best diagnostic procedure., Conclusions: Meckel's diverticulum must be considered an emergency in children. Meckel's diverticulum, has to be ruled cut as in infants with significant bleeding, as well as in children with intestinal occlusion. The best method for diagnosis is 99mTc-pertechnetate scanning.

Objective: To assess the frequency and clinical picture of Hepatoportal Sclerosis in a population of Mexican children of the Instituto Nacional de Pediatría, México City., Background: Hepatoportal Sclerosis is a disease of unknown etiology. It's diagnosis is difficult. The main clinical presentation is splenomegaly with or without hematemesis (portal hypertension). Splenoportography and liver histology study are the best procedures for diagnosis and must be performed by experts., Methods: We studied 7/106 children with portal hypertension during a period of 10 years, who were seen at the Instituto Nacional de Pediatría, México city. Inclusion criteria were specific findings of splenoportography and histologic changes in liver biopsy., Results: We found 7/106 children. The main clinical manifestation were splenomegaly and hematemesis. We did not find any previous history of contact with arsenic, vinyl chloride or copper sulfate. In 6/7 children a porto-systemic shunt was performed. Only one received propranolol and sclerotherapy. At the time of this report all children have shown a good clinical course.

We studied by ELISA test 450 healthy children looking for IgG and IgM antibodies against virus A hepatitis. 376/450 (86.3%) showed IgG antibodies. 50% of children under one year were positive. At 3 years of age 80% of children from this study were with antibodies IgG and 96% of children at 10 years of age were positive. Only 9 children showed antibodies IgM.

Background: Different antibiotics, antagonist H2 and others have been used for elimination and/or eradication of Helicobacter pylori., Aims: Evaluate elimination of Helicobacter pylori with amoxicillin, bismuth subsalicylate and ranitidine; and the improvement of recurrent abdominal pain., Method: 20 children with recurrent abdominal pain associated to gastritis and histologic identification of Helicobacter pylori were studied under a period of 18 months (January 1992 to June 1993), at Instituto Nacional de Pediatría, México, D.F. All children were treated simultaneously with: Amoxicillin, 15 days, plus ranitidine and bismuth subsalicylate for one month., Results: Helicobacter pylori was eliminated in 14 of 20 children studied. All these children had an important improvement of recurrent abdominal pain., Conclusion: Elimination of Helicobacter pylori and clinical improvement was present in 14 of 20 children studied (70%).

Background: Shwachman syndrome has been recognized as the second most frequent cause of pancreatic insufficiency in children and its is related to hematological and bony abnormalities., Aims: To know the main clinical symptoms, analytical data, radiological and sonographic findings in the Shwachman syndrome., Materials and Methods: We present a 1 year 4 months old girl with Shwachman syndrome. We reviewed the clinical history taking into consideration height/weight relationship according to percentiles and physical examination. Analytical data: blood counts, fetal hemoglobin, vitamin B12 and folate levels, bone marrow examination, stool cultures and examination for ova and parasites, transaminase levels, sweat electrolytes, serologic tests for viral hepatitis. Radiological studies: bone series and bone age, abdominal sonography and computed tomography. Liver and intestinal biopsies., Results: In this patient we confirmed the presence of exocrine pancreatic insufficiency, dysfunction of the bone marrow and bony abnormalities typical in Shwachman syndrome.

Objective: Elimination of Helicobacter pylori with Chlaritromicin, Bismuth subsalicylate and Ranitidine; and improvement of recurrent abdominal pain. ANTECEDENT: Different antibiotics, antagonist H2 and others has been used for elimination and, or eradication of Helicobacter pylori., Method: 22 children with recurrent abdominal pain associated to gastritis and histologic identification of Helicobacter pylori were studied under a period of 18 months (january 1992 to june 1993), at Instituto Nacional de Pediatría, México, D:F: All children were treated simultaneously with: Chlaritromicin, 15 days, Plus ranitidine and bismuth subsalicylate for one month., Results: Helicobacter pylori was eliminate in 14 of 22 children studied. All these children had an important improvement of recurrent abdominal pain., Conclusion: Elimination of Helicobacter pylori and clinical improvement was present in 14 of 22 children studied (63.7%).

We studied 100 healthy children looking for lactose malabsortion. We performed in all of them the lactose breath test. We found a 10% with lactose malabsortion. There was no correlation between lactose breath test and fecal reducing substances.

We studied 450 healthy children between 3 months old and 17 years old who were seen at the Instituto Nacional de Pediatría during a period of one year (September 1992 June 1993). The EUSA test was positive in 4/450, 0.9%. The RIBA test was positive in these four children.

We performed a rectal motility study in 39 children with encopresis and in 41 with chronic functional constipation. A three balloon system Schuster technic, was employed. Pressure changes were recorded. The "Inflation" reflex was absent in 23/39 children with Encopresis 59% and in 11/41. 26.8% with chronic functional constipation (p < 0.05).

We studied 40 children with recurrent abdominal pain during a period of six months (january to june 1993) entered at the gastroenterology service of the Instituto Nacional de Pediatria in México City. In all of then we performed in all of them an upper gastrointestinal endoscopy with 3 biopsies from gastric mucosa (antrum) for histological examination and urease tests. We also did an ELISA test looking for an H. Pylori specific serum IgG response. Our control group were 40 healthy children in whom we did only the ELISA test. We did not find any statistics differences between the histologic findings (gold standard) and the urease and ELISA tests. With IgG antibodies prevalence for H. Pylori in children with recurrent abdominal pain were 57% in contrast with our control group in whom the prevalence was 5%.

We studied 26 children with congenital hepatic fibrosis during the period 1971-1993. About half of the children were about the 6 years old. Only two had brothers with same disease. The chief clinical manifestation was hematemesis associated or not with liver enlargement, predominantly of left lobe. Only one case showed fever and cholangitis. Liver function tests were usually normal. Twenty-two children had portal hypertension. Liver biopsy was of definitive for diagnosis. Seven children died.

Eight children with arteriovenous malformations of the gastrointestinal tract were studied during a two year period (1989-1993). The main localization of the arteriovenous malformations were: ascending colon (five cases), descending colon (five cases), terminal ileum (three cases), rectum and sigmoid (three cases). Diagnosis approach was made with colonoscopy and arteriography. Surgical resection of the affected segments was the therapeutical procedure in seven of the eight cases.

We studied 5 children with intestinal malakoplakia who were seen during a period of 10 years. Four were male and one female. The main clinical manifestations were: chronic bloody and mucous diarrhea, abdominal pain and polypoid masses detected by rectal maneuver. Either the radiological study as well as endoscopy showed the presence of stenosis and polypoid masses (pseudopolyps). Two patients underwent laparotomy and a tumoral infiltration at the level of rectal-sigmoid and cecal appendix was found. Histological diagnosis proves to be definitive in these case. Drug treatment has been with bethanechol, trimethoprim-sulfamethoxazole in three patients. We conclude that intestinal malakoplakia is more common that ulcerative colitis in our children population attending at this institute. Therefore, the presence of intestinal malakoplakia must be ruled out in every child having chronic bloody and mucous diarrhea, presenting as well pseudopolyps.