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Background: Vitamin D plays an important role in maintaining bone health with numerous benefits for extraskeletal health as well. Objectives: We aimed to assess the prevalence of vitamin D deficiency in children (0–18 years old) in a tertiary hospital in Romania between August 2019 and January 2024 and to investigate the role of adequate supplementation in this vulnerable population. Methods: The serum 25(OH)D levels were measured using a chemiluminescence binding assay. Results: A total of 744 participants were included in this study: 396 female (53.23%) and 348 male (46.77%). The serum levels of 25(OH)D ranged between 2.2 and 125.4 ng/mL, with a mean value of 27.4 ng/mL and a median value of 23.5 ng/mL. According to the cutoff values for the definition of vitamin D status (severe deficiency: <10 ng/mL, deficiency: <20 ng/mL, insufficiency: 20–29 ng/mL, and sufficiency: ≥30 ng/mL), the sample consisted of 77 (10.34%) cases of severe deficiency, 221 (29.7%) cases of deficiency, 194 (26.07%) cases of insufficiency, and 245 (32.93%) cases of sufficiency. There were seven cases of hypervitaminosis D with values above 100 ng/mL. The mean values (and corresponding 95% confidence intervals, CIs) were as follows: 27.85 ng/mL [25.95–29.76] in the males, 22.45 ng/mL [25.12–28.82] in the females, 24.82 ng/mL [21.86–27.77] in the spring, 28.62 ng/mL [26.42–30.81] in the summer, 32.30 ng/mL [29.16–35.44] in the autumn, and 24.01 ng/mL [21.57–26.44] in the winter. We observed a notable decline in the serum 25(OH)D levels with age, with 82.08% of the children in the age group above 6 years old having serum 25(OH)D levels below 30 ng/mL. In obese subjects, a higher prevalence of hypovitaminosis D was observed compared to non-obese subjects, with a mean value of 19.54 [17.50–21.57] ng/mL in obese children versus 28.89 [27.39–30.40] ng/mL in normal weight children. Conclusions: In our sample, the mean serum concentration of 25(OH)D was 27.4 ng/mL. Notably, 66.11% of the cases demonstrated varying degrees of hypovitaminosis D, with a significantly higher prevalence of 86.16% observed in the obese group. Healthcare providers should prioritize routine screening for vitamin D levels in pediatric patients with obesity to facilitate timely intervention and personalized supplementation strategies tailored to individual needs [ABSTRACT FROM AUTHOR]

Congenital hyperinsulinism (CHI) is a rare disorder of glucose metabolism and is the most common cause of severe and persistent hypoglycemia (hyperinsulinemic hypoglycemia, HH) in the neonatal period and childhood. Most cases are caused by mutations in the ABCC8 and KCNJ11 genes that encode the ATP-sensitive potassium channel (KATP). We present the correlation between genetic heterogeneity and the variable phenotype in patients with early-onset HH caused by ABCC8 gene mutations. In the first patient, who presented persistent severe hypoglycemia since the first day of life, molecular genetic testing revealed the presence of a homozygous mutation in the ABCC8 gene [deletion in the ABCC8 gene c.(2390+1_2391-1)_(3329+1_3330-1)del] that correlated with a diffuse form of hyperinsulinism (the parents being healthy heterozygous carriers). In the second patient, the onset was on the third day of life with severe hypoglycemia, and genetic testing identified a heterozygous mutation in the ABCC8 gene c.1792C>T (p.Arg598*) inherited on the paternal line, which led to the diagnosis of the focal form of hyperinsulinism. To locate the focal lesions, (18)F-DOPA (3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine) positron emission tomography/computed tomography (PET/CT) was recommended (an investigation that cannot be carried out in the country), but the parents refused to carry out the investigation abroad. In this case, early surgical treatment could have been curative. In addition, the second child also presented secondary adrenal insufficiency requiring replacement therapy. At the same time, she developed early recurrent seizures that required antiepileptic treatment. We emphasize the importance of molecular genetic testing for diagnosis, management and genetic counseling in patients with HH. [ABSTRACT FROM AUTHOR]

This article from the Romanian Journal of Oral Rehabilitation focuses on the oral manifestations of anorexia in adolescent patients. It highlights the specific challenges faced by this population in terms of oral health and emphasizes the importance of early intervention and tailored dental care strategies. The article discusses various oral health complications that can arise from anorexia, such as enamel acid solubility and periodontitis, and emphasizes the need for regular dental check-ups and proper nutrition. It also mentions the impact of the COVID-19 pandemic on eating disorders among teenagers and the importance of primary care providers in evaluating and treating these disorders. [Extracted from the article]

This article examines the connection between the oral and gut microbiota in pediatric inflammatory bowel disease (IBD). The study reveals that children with IBD have distinct changes in their oral microbiome, which could potentially be used as diagnostic markers. The research also looks at how the oral microbiota changes before and after IBD treatment. The findings emphasize the importance of oral health in managing pediatric IBD and highlight the need for collaboration between dental and medical professionals. [Extracted from the article]

Ingestion of cylindrical batteries is a rare condition in children. There are no clear guidelines regarding the appropriate management of this condition. We present 2 such cases; one patient required endoscopic removal of the battery, while in the other one the battery passed spontaneously. We recommend that such cases be admitted for monitoring and treated on an individual basis, according to the clinical picture, X-ray data and the availability of pediatric emergency endoscopy. [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]

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]

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]

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]

Strategiile utilizate în tratamentul infecţiei cu Helicobacter pylori la copii derivă în mare parte din schemele de tratament stabilite de consensuri clare la pacienţii adulţi. Tripla terapie ce asociază inhibitori de pompă protonică (IPP), claritromicina şi amoxicilina este utilizată pe scară largă În Întreaga lume; alături de aceasta s-au impus şi alte asocieri bazate fie pe IPP, fie pe săruri de bismut. La ora actuală au fost introduse noi preparate În schemele antibacteriene, alături de esomeprazol, pantoprazol sau lansoprazol aflându-se azitromicina şi fluorochinolonele (la copiii mari). În acelasi timp au fost propuse terapii de linia a doua, rezervate cazurilor de recădere sau reinfecţie bacteriană, acestea fiind reprezentate de asocieri cvadruple bazate pe săruri de bismut sau de regimuri ce includ fluorochinolone; nu în ultimul rând, introducerea terapiei secvenţiale la copii reprezintă o alternativă promiţătoare. Pe plan profilactic, vaccinarea orală sau intramusculară, aceasta din urmă aflată În faze avansate de testare clinică, va putea contribui în viitor la scăderea incidenţei infecţiei cu H.pylori, a gastritei, ulcerului şi cancerului gastric. [ABSTRACT FROM AUTHOR]

Gastritele sunt inflamații acute sau cronice, difuze sau focale ale mucoasei stomacului. O clasificare ideală a gastritelor trebuie să se bazeze în primul rând pe etiologie şi apoi pe aspectele structurale, epidemiologice, prognostice. Infecția cu Helicobacter pylori reprezintă cauza cea mai frecventă de gastrită cronică la vârsta pediatrică. Gastrita cu Helicobacter pylori începe tipic ca o gastrită acută antrală, caracterizată prin inflamație intensă ce se extinde în timp, implicând întreaga mucoasă gastrică şi producând gastrită cronică. Simptomatologia este complexă, dar nespecifică, şi implică sindromul funcțional digestiv. Testele de detectare ale infecției sunt invazive şi noninvazive. Complicațiile apar în special în cazurile de eşec terapeutic în eradicarea bacteriei. [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]

Sindromul Roviralta reprezintă asocierea dintre stenoza hipertrofică de pilor şi hernia hiatală. Autorii prezintă cazul unui copil de sex masculin în vârstă de 2 luni internat în Clinica a V-a de Pediatrie a Spitalului de Urgență pentru Copii „Sfânta Maria“, Iaşi pentru vărsături postprandiale şi pierderea progresivă în greutate. Tranzitul esogastroduodenal baritat relevă hernie hiatală, canal piloric îngustat şi reflux gastroesofagian prezent inconstant. Ecografia a confirmat hipertofia olivei pilorice şi pH-metria, refluxul gastroesofagian. Tratamentul medical cu antispastice, rehidratarea, inhibitori de pompă de protoni şi prokinetice a avut succes, iar evoluția a fost bună. [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]

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]

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]

Ulcerul gastroduodenal este o patologie nu atât de rară în patologia pediatrică pe cât se credea. Lucrarea abordează aspectele esenţiale ale terapiei dietetice şi medicamentoase. Tratamentul medicamentos foloseşte un întreg arsenal farmacologic: antiacide, protectoare gastrice antagonişti de H2 receptori, inhibitori de pompă protonică, iar în plus, pentru eradicarea infecţiei cu Helicobacter pylori, antibioterapia cu 2 antibiotice. [ABSTRACT FROM AUTHOR]

Chistul congenital de coledoc este mai frecvent diagnosticat la copiii până la 10 ani, afectând preponderent persoanele de sex feminin. Prezentăm un caz de chist coledocian la un sugar de sex masculin în vârstă de 7 luni, care a debutat brusc cu icter sclerotegumentar şi inapetenţă. Ecografia abdominală a evidenţiat o formaţiune transsonică, hiperreflectogenă, cu localizare pe topografia coledocului, căi biliare intrahepatice dilatate, iar examenele de laborator au decelat un sindrom sever de citoliză hepatică şi colestază. Diagnosticul a fost confirmat cu ajutorul IRM colangiopancreatic efectuat în urgenţă şi a impus intervenţia chirurgicală. Diagnosticul diferenţial al sindroamelor de colestază trebuie să excludă şi chistul coledocian, indiferent de vârsta pacientului, din cauza complicaţiilor şi riscului de malignizare. [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]

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]

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]

Rolul bacteriei Helicobacter pylori în patogeneza bolilor digestive este foarte bine stabilit şi cunoscut în prezent, însă ultimele cercetări argumentează implicarea Helicobacter pylori în producerea unor afecțiuni extradigestive. Prevalența infecției diferă de la o zonă geografică la alta, fiind în declin în țările dezvoltate şi menținându-se încă ridicată la populația din țările în curs de dezvoltare. H. pylori determină din partea gazdei un răspuns imun care implică imunitatea umorală şi celulară. Infecția este localizată la nivelul mucoasei gastrice, dar s-a demonstrat că anumite boli alergice sunt consecința, cel puțin la o parte din bolnavi, a infecției cronice cu H. pylori. Suferințele gastrointestinale manifestate prin grețuri, vărsături, inapetență, dureri epigastrice, pot fi asociate şi cu tulburări nutriționale. Infecția cu H. pylori se asociază cu anemie, scădere ponderală şi staturală. Bacteria a fost identificată şi la majoritatea pacienților diabetici cu neuropatie autoimună producând tulburări electrice gastrice, întârzierea evacuării stomacului, manifestări responsabile de simptomele dispeptice. Conduita terapeutică corectă realizată în cazul pacienților cu afecțiuni extradigestive şi o eventuală infecție cu H. pylori trebuie să vizeze atât tratamentul bolii de bază cât şi eradicarea eficientă a infecției. [ABSTRACT FROM AUTHOR]

The role of Helicobacter pylori bacteria in the pathogenesis of the digestive diseases now, is very well established and known, but recent research claims that Helicobacter pylori is involved in producing some extra-digestive diseases. The prevalence of the infection differs from one geographical area to another, registering a descending trend in developed countries and remaining at a constant level or even increasing in developing countries. Helicobacter pylori determines an immune response of the host, which involves humor and cell immunity. The infection is located in the gastric mucosa, but in recent years we have seen studies that try to explain some allergic diseases as the consequence, at least in some patients, of the chronic infection with Helicobacter pylori. The gastro-intestinal sufferings caused by the infection with H. pylori manifested by nausea, vomiting, anorexia, epigastric pains can be associated with nutritional disorders. Many recent studies prove that the infection with H. pylori is associated with anemia, and weight loss. Helicobacter pylori was identified in most diabetic patients with autoimmune neuropathy, causing electric gastric disorders, the delay of the stomach evacuation, manifestations responsible of the dyspeptic symptoms in diabetic patients. The appropriate therapeutic behavior in the case of patients with extra-digestive affections and an eventual infection with H. pylori should concern both the basic disease treatment and the efficient eradication of the infection. [ABSTRACT FROM AUTHOR]

În ultimul deceniu constipația a devenit o problemă actuală de adresabilitate în serviciile de gastroenterologie pediatrică. Obiective. Ne-am propus un studiu pentru a identifica prevalența constipației şi stabilirea unor corelații între dietă şi mediul socio-familial la copii cu vârste cuprinse între 1 şi 17 ani, internați în serviciul de Gastroenterologie, Spitalul Clinic de Urgență pentru Copii „Sfânta Maria“ Iaşi, în perioada 1 ianuarie 2012 - 1 ianuarie 2014. Rezultate. Grupul de studiu a constat dintr-un lot de 994 de pacienți, reprezentând 9,6% din totalul copiilor spitalizați. În ceea ce priveşte prevalența constipației nu am observat o diferență semnificativă între sexe, raportul F/M a fost de 1,3/1, dar am remarcat o proporție semnificativă de pacienți provenind din mediul urban 68% (676) față de 32% (318) din mediul rural. În ceea ce priveşte mediul socio-familial: 34% (338) dintre copii trăiesc cu bunicii, 13,9% (139) provin din familii monoparentale, 6,7% (67) sunt în grija unui asistent maternal şi 2,6% (26) vin din centrele de plasament. În lotul studiat un procent mic de copii au fost alăptați, respectiv, 26,2% (261), în prima lună, 10,7% (107) timp de 3 luni în timp ce la 6 luni 98,1% (976) dintre copii au primit o formulă de lapte. Diversificarea a fost făcută incorect în cazul a 41 % (408) dintre pacienți. Doar 14,6% (145) au raportat consumul zilnic de fructe şi legume, în timp ce 51,1 % (508) au luat masa cel puțin o dată pe săptămână la restaurante de tip fast-food. 21,6% (214) practică sport cel puțin 2 ore/săptămână, în timp ce 48,7% (484) petrec cel puțin 3 ore/zi la televizor. 12,8% (128) dintre pacienți sunt supraponderali şi 5,7% (57) obezi. Concluzii. Constipația este o boala care afectează copiii de toate vârstele. Nu sunt diferențe notabile între sexe. Se remarcă o pondere crescută a pacienților din mediu urban cu predominanța unui regim alimentar inadecvat, lipsa activității fizice, precum şi o pondere crescută a pacienților supraponderali. Un rol important în modificările psihologice îl deține mediul socio-familial. [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]

The paper presents a family with hereditary transmitted Marie-Sainton dysplasia affecting the father and his both children. This is a rare syndrome presenting an autosomal pattern of inheritance, characterized by a generalized defect in both membranous and endochondral bone formation resulting in clavicular aplasia, delayed ossification of the fontanelles and the sutures of the skull and prolonged retention of deciduous dentition with delayed eruption of the permanent teeth. The diagnosis is suggested by more or less complete clinical picture and confirmed by multiple radiological explorations (skull, thorax, spinal column, pelvis) and genetical examination. The genetic mutation for cleidocranial dysplasia (CCD) is found on chromosome six and is called CBFA1 (short for core biding factor al or RUNX2) and is the only gene known to be associated with CCD. The normal version of CBFA1 acts to induce osteoblasts which are the type of cells that lay down bone. Although associated psychosocial disorders can occur, the prognosis and life expectancy of this condition are favorable being conditioned however by the complexity of orthodontic procedures which are determinant for these patients life quality.

An unusual association between an arachnoid cyst and a decompensated pyloric stenosis in a three years-old boy is presented. The little patient was admitted into hospital with haematemesis, melena, influenced generally condition and acute posthemorrhagic anaemia following aspirin intake for hypertermia. Specific intensive care was successful and the little patient was discharged but without an upper digestive endoscopy(parents refusal, technical reasons). After one week he returned with progressive worsening vomitings and an intracranial hypertension was suspected. CT documented an arachnoid cyst in the right middle cranial fossa and the patient is directed to the Neurosurgical Clinic where a cyst fenestration was done. Subsequent to operation the vomitings reinstaled with severe dehydration and an upper GI series showed a decompensated pyloric stenosis. He was operated on underwenting an antrectomy. Finally the child recovered with good short and long-term evolution. The coincidental presence of an intracranial congenital mass and a complicated aspirin-induced peptic ulcer in this young patient, misleaded us and in the lack of an early endoscopy an intempestive neurosurgical operation was initially done.