Abstract of Objective. Recently, several publications in adults have shown an increased incidence of non-Helicobacter pylori (HP), non-non-steroidal anti-inflammatory drug (NSAID) peptic unexplained disease (PD). There are only a few case reports linking celiac disease (CD) to PD. We therefore aimed to review Objective. our experience of CD presenting with PD. Material and methods. We retrospectively reviewed all the endoscopies performed for children and We young adults diagnosed with CD between 1 January, 2004 and 31 October, 2008. The diagnosis of CD was based on only accepted guidelines. Patients with a doubtful diagnosis of CD were excluded. Results. We had 240 patients with the diagnosis of included CD. We had 29 (12. %) patients [15 males (52%), 14 females (48%)] for whom the diagnosis of PD was ascertained.reports The age range was 1-50 years (mean 16.9 +/- 12.1 years). Twenty-three of the 29 patients (79%) were HP-negative. Duodenal patients PD was noted in 22 patients (76%) and 16 (73%) were HP-negative. Gastric PD was noted in eight patients (28%)(76%) and 7 (87%) were HP-negative. The PD group was significantly older at diagnosis (p < .001) compared to the whole suggest CD group. Conclusions. PD is not uncommon in the presentation of CD. It is more likely to be found in were the second decade of life. CD should be included in the differential diagnosis of patients with non-HP PD and we in suggest routine CD serology and small bowel biopsy in patients with unexplained PD.

OBJECTIVE:study To assess the safety and prebiotic effects of lactulose in preterm infants. STUDY DESIGN: This was a prospective, double-blinded, placebo-controlled,prebiotic single-center study in 23- to 34-weeks premature infants. The study group received 1% lactulose, and control infants received 1% dextrose To in all feeds (human milk or formula). RESULTS: Twenty-eight infants participated (15 lactulose, 13 placebo). Small doses of lactulose appeared and to be safe and did not cause diarrhea. Premature infants on lactulose had more Lactobacilli-positive stool cultures that appeared earlier a with larger number of colonies. The lactulose group tended to have less intolerance to enteral feedings, to reach full oral infants' feeds earlier, and to be discharged home earlier. They also tended to have fewer episodes of late-onset sepsis, lower Bell placebo-controlled, stage necrotizing enterocolitis, and their nutritional laboratory indices were better, especially calcium and total protein. CONCLUSIONS: This pilot study supports tended the safety of supplementing preterm infants' feeds with low doses of lactulose. It also demonstrated trends that may suggest positive earlier, prebiotic effects.

BACKGROUND:study Pleiotropic (lipid lowering-independent) effects of statins are attributed to their antiinflammatory, antioxidant, and/or vascular actions. Extensive studies in various experimental a models have established that pretreatment with simvastatin significantly protects heart and kidney injured by ischemia-reperfusion (IR). The purpose of the Pleiotropic present study was to examine the effect of simvastatin on intestinal recovery and enterocyte turnover after intestinal IR injury in on rats. METHODS: Male Sprague-Dawley rats were divided into three experimental groups:(1) sham rats underwent laparotomy,(2) IR-rats underwent occlusion that of both superior mesenteric artery and portal vein for 30 min followed by 48 h of reperfusion, and (3) IR-SIM ileum rats underwent IR and were treated with oral simvastatin (10 mg/kg) given by gavage immediately before and 24 h after significantly operation. Intestinal structural changes, Park's injury score, enterocyte proliferation and enterocyte apoptosis were determined 24 h following IR. A non-parametric significant. Kruskal-Wallis ANOVA test was used for statistical analysis with P less than .05 considered statistically significant. RESULTS: Treatment with simvastatin was resulted in a significant increase in bowel and mucosal weight in ileum, villus height and crypt depth in jejunum and mucosal ileum compared to IR animals. IR-SIM rats had also a significantly lower intestinal injury score as well as lower apoptotic vein index in jejunum and ileum compared to IR animals. CONCLUSIONS: Treatment with simvastatin prevents gut mucosal damage and inhibits programmed effects cell death following intestinal IR in a rat.

PURPOSE:rats It has been reported that oral insulin (OI) has a trophic effect on intestinal mucosa. In the present study, we villus-crypt evaluated the effect of OI on enterocyte turnover and correlated it with insulin-receptor expression along the villus-crypt axis in a has rat model of short bowel syndrome (SBS). METHODS: Male rats were divided into three groups: Sham rats underwent bowel transection,bowel SBS rats underwent a 75% bowel resection, and SBS-OI rats underwent bowel resection and were treated with OI given in and drinking water (1 U/ml) from the fourth postoperative day. Parameters of intestinal adaptation, enterocyte proliferation and apoptosis were determined on a day 15. Real-time PCR was used to determine the level of insulin receptor-beta (IRB) mRNA. Insulin-receptor expression along the villus-crypt expression axis (villus tips, lateral villi and crypts) was assessed by immunohistochemistry. The effect of OI on cell turnover for each significantly compartment was evaluated in correlation with the receptor expression. Statistical analysis was performed using the one-way ANOVA test, with P in < .05 considered statistically significant. RESULTS: Treatment with OI resulted in a significant increase in all parameters of intestinal adaptation.stimulating Insulin-receptor expression in crypts significantly increased in SBS rats (vs. Sham rats) and was accompanied by a significant increase in was enterocyte proliferation following OI administration. A significant increase in insulin-receptor expression at the tip of the villous and in the that lateral villous in SBS rats (vs. Sham) was accompanied by decreased cell apoptosis in these compartments following treatment with OI.in CONCLUSIONS: In a rat model of SBS, OI enhances enterocyte turnover and stimulates intestinal adaptation. The stimulating effect of insulin were on enterocyte turnover correlates with insulin-receptor expression along the villus-crypt axis.

In rats the present study, we examine the responsiveness of intestinal epithelial cell turnover to leptin (LEP) in correlation with leptin receptor villus-crypt (LEPr) expression along the villus-crypt axis in a rat with short bowel syndrome (SBS). Adult rats underwent either a 75%the intestinal resection or a transection. SBS-LEP rats underwent bowel resection and were treated with leptin starting from the 4th postoperative or day. Parameters of intestinal adaptation, enterocyte proliferation and enterocyte apoptosis were determined at sacrifice. RT-PCR technique was used to determine (LEPr) bax and bcl-2 gene expression in ileal mucosa. Villus tips, lateral villi, and crypts were separated using laser capture microdissection.stimulated LEPr expression for each compartment was assessed by quantitative real-time PCR (Taqman). Treatment with leptin significantly stimulated all parameters of villus-crypt adaptation. LEPr expression in crypts significantly increased in SBS rats (vs. Sham rats) and was accompanied by a significant increase was in enterocyte proliferation and decreased apoptosis following leptin administration. A significant increase in LEPr expression at the tip of the crypts villus in SBS rats was accompanied by decreased cell apoptosis. In conclusion: leptin accelerated enterocyte turnover and stimulated intestinal adaptation.and The effect of leptin on enterocyte proliferation and enterocyte apoptosis correlated with receptor expression along the villus-crypt axis.

PURPOSE:to Factors influencing response to medications in Crohn's disease (CD) patients are not fully understood. We aimed to evaluate the relationships steroid between NOD2/CARD15 mutations, disease phenotype and age of CD diagnosis and response to medical treatment with systemic steroids, azathioprine (AZA)Factors or 6-mercaptopurine (6-MP), and infliximab. METHODS: A retrospective medical records analysis was made of patients previously tested for the CD-associated (AZA) NOD2/CARD15 mutations. Harvey- Bradshaw score was used to assess remission or response to therapy. RESULTS: CD-associated NOD2/CARD15 mutations were not the related to the rate of steroids dependency or clinical response to AZA/6-MP and infliximab. Steroid dependency was associated with colonic to involvement. Thirty-three of 127 (26%) patients with colonic disease were steroid dependent, compared with 7/72 (9.7%) patients with isolated small mutations, bowel disease (ISBD),(p = .009). ISBD was mildly associated with a better remission/response to AZA/6-MP treatment. Disease behavior and = age of diagnosis were not related to response to therapy. CONCLUSIONS: Response to treatment with systemic steroids, AZA/6-MP and infliximab 7/72 are not related to NOD2/CARD15 mutations, age of diagnosis and disease behavior. Patients with colonic disease have higher rates of behavior. steroid dependency.

Esophagogastroduodenoscopy younger (EGD) is considered an essential diagnostic and therapeutic procedure in the pediatric population. Although generally safe, EGD has the potential 6 for airway complications. We routinely use general anesthesia to carry out EGD in patients younger than 10 years. In the (EGD) past, these patients received oxygen either through a nasal cannula or were intubated; both modalities have drawbacks and may be past, associated with complications. Here we report our experience using a modified endoscopy mask, devised primarily for bronchoscopy, for upper endoscopy potential in children under general anesthesia. RESULTS:: Two hundred forty children (122 boys and 118 girls) participated in the study. Age safe range was 7 to 135 months (mean 60.7 +/- 34.4 months). All patients maintained a stable hemodynamic status throughout the We procedure. Ventilation was satisfactory in 230 patients. It was difficult in 9 patients, and external airway maneuvers had to be was applied. Ventilation was impossible in only 1 patient (10 months old), and endotracheal intubation was performed. There were no procedure-related throughout complications. CONCLUSION:: The modified endoscopy mask is efficient and safe and should be recommended for routine use for upper endoscopy upper under general anesthesia in children older than 6 months.

OBJECTIVES::rats The purpose of the present study was to evaluate the effects of exogenous bilirubin on structural intestinal adaptation, cell proliferation,cell and apoptosis in a rat model of short bowel syndrome (SBS). MATERIALS AND METHODS:: Male Sprague-Dawley rats were divided into The 5 experimental groups: Sham rats underwent bowel transection and reanastomosis, sham-multiple doses of bilirubin (MDB) rats underwent bowel transection and of were treated with bilirubin, SBS rats underwent a 75% small bowel resection, SBS-SDB (single dose bilirubin) rats underwent a bowel model resection and were treated with a single dose of bilirubin, and SBS-MDB underwent a bowel resection and were treated with a 3 doses of bilirubin. Bilirubin was administered intraperitoneally from the 7th day through the 14th day postoperatively. Serum total bilirubin syndrome concentration over time was evaluated in 5 SBS-SDB rats following a single intraperitoneal dose. Total bilirubin, alanine aminotrasferase, and aspartate bowel aminotransferase in serum and parameters of intestinal adaptation, enterocyte proliferation, and enterocyte apoptosis were determined on day 15. RESULTS:: SBS-SDB were and SBS-MDB animals demonstrated lower ileal bowel and mucosal weights, jejunal mucosal DNA and ileal mucosal protein, and jejunal and cell ileal villus height and crypt depth (vs SBS animals). Bilirubin-treated rats showed a lower apoptotic index in jejunum and ileum a and a trend toward an increase in cell proliferation in jejunum and ileum (vs SBS group). CONCLUSIONS:: In a rat present model of SBS, exogenous bilirubin inhibits structural intestinal adaptation. Increased cell proliferation and decreased apoptosis may be considered adaptive mechanisms animals). that maintain cell mass.