Vasundhara Tolia

Background: Gastroesophageal reflux disease (GERD) is believed to be more common in adult males as compared to females. It also has been shown in adults to be more common in Caucasians. We wanted to determine ethnicity and gender related differences for extended pH monitoring parameters in infancy.Methods: Extended pH monitoring data (EPM) from infants 5 minutes as compared to AA females in the control group (p = 0.05). Furthermore, Caucasian females with GERD showed an overall higher trend for all parameters. Caucasian males had a trend for higher mean number of reflux episodes as compared to AA males in the control group (p = 0.09).Conclusion: Although gender specific control data do not appear warranted in infants undergoing EPM, ethnic differences related to an overall increased incidence of pathologic GERD in Caucasian infants should be noted.

Our aims were to compare the specificity and sensitivity of the reflux index (RI), Euler and Byrne score (EBS), and area under the curve (AUC) at pH < 4.0 in infants 1 year old for identifying pathologic gastroesophageal reflux (GER) and to identify new cutoffs on formula feedings. We undertook a prospective investigation of extended pH monitoring (EPM) in 117 infants with symptoms of GER. Infants were categorized as having pathologic reflux by three measures: RI ≥ 5%, EBS ≥ 50, or AUC pH < 4.0 or ≤ 21.3, as determined by receiver operating characteristic (ROC) curve analysis. Using the RI as a criterion, 27 infants (23%) had pathologic reflux. When EBS and AUC were used, 65 (56%), and 67 (57%) respectively, were classified as having pathologic reflux. The specificities of RI, EBS, and AUC were 97.8, 100.0, and 100.0%, respectively, and the sensitivities were 93.0, 91.5, and 94.4, respectively. A new cutoff value for RI of 2.1% was determined using ROC curve analysis to improve the specificity and sensitivity of RI to the above values. The number of infants with pathologic GER is likely to be significantly less using the traditional RI alone on formula feedings, however, the revised RI cutoff value and AUC analysis by computerized pH tracings can enhance the accuracy on formula feedings.

Background.  To determine the presence of Helicobacter species in the liver biopsy specimens from children with various chronic liver diseases as data in adult literature suggests a possible role of these bacteria in their pathogenesis.Materials and methods.  Paraffin sections of 61 liver biopsies of pediatric patients with miscellaneous diseases and autopsy liver tissue from 10 control subjects with no evidence of preexisting liver disease were examined for the presence of Helicobacter species by a genus‐specific seminested polymerase chain reaction (PCR) assay. PCR–products of positive samples were further characterized by denaturing gradient gel electrophoresis (DGGE) and DNA‐sequence analysis. Based on those results, a seminested PCR assay for H. ganmani was developed and applied to the samples.Results.  On analysis, 40/61 patient samples were positive in the genus‐specific Helicobacter PCR and 4/10 from the control group. The nucleotide sequences of 16S rDNA fragments were 99–100% similar to mainly Helicobacter sp. ‘liver’ and H. ganmani. PCR‐products similar to H. canis and H. bilis were also found. The 16S rDNAs of control specimens showed similarity to Helicobacter sp. ‘liver’. In the H. ganmani‐specific PCR analysis 19 patients, but none of the controls, were positive.Conclusions.  Amplified Helicobacter 16S rDNAs were related to Helicobacter sp. ‘liver’ or H. ganmani in liver biopsy specimens of pediatric patients. The possible significance of Helicobacter species in pediatric liver diseases needs to be evaluated further in prospective studies.

Objective: To compare the flavor and taste preference of two acid-inhibitory therapies in healthy children aged between 5–11 years. Methods: A single-site, single-blind, taste test trial was conducted in which 111 children participated after parental consent. One teaspoonful (5mL) of lansoprazole delayed-release oral suspension (strawberry-flavored) and ranitidine oral syrup (peppermint-flavored) were provided to each child with a 10-minute break between samples. Children tasted the sample, swished it in their mouth for 10 seconds, and then expectorated the sample. Spring water and crackers were used to clear the palate between samples. After each sampling, children were observed for facial expressions and asked to rate their degree of liking of each sample based on a 5-point facial hedonic scale (5 = like it very much, 1 = dislike it very much). Likes, dislikes, and product preference were recorded. Results: Of the 56 female and 54 male children who tasted both samples, 95% (105/110) preferred lansoprazole. Taste and flavor were the most often cited reasons for preferring lansoprazole (61 and 17 children, respectively) while three children preferred the flavor of ranitidine oral syrup. Lansoprazole received a higher mean liking rating compared with ranitidine (mean liking scores of 4.1 and 2.2, respectively). There was no significant difference in the preference for lansoprazole between age groups and gender with the degree of liking scores ranging between 3.5–4.4. Forty-two children disliked the texture of the lansoprazole oral suspension, citing the granules (31/110), thickness (7/110), or consistency/texture (4/110), specifically. Conclusion: After sampling both products, 95% of children preferred the flavor and taste of the strawberry-flavored lansoprazole delayed-release oral suspension compared with the peppermint-flavored ranitidine oral syrup.