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Low FODMAP Diet Is Not Effective in Children with Functional Abdominal Pain: A Randomized Controlled Trial.
Boradyn, KM, Przybyłowicz, KE, Jarocka-Cyrta, E
Annals of nutrition & metabolism. 2020;(5):334-344
Abstract
INTRODUCTION A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has been shown to reduce symptoms among adult patients and children with irritable bowel syndrome. There are no studies investigating the effectiveness of the low FODMAP diet in pediatric patients with functional abdominal pain (FAP). OBJECTIVE The study aimed to evaluate the effectiveness of the low FODMAP diet in reducing gastrointestinal symptoms in children with FAP in comparison to the control diet based on the National Institute for Health and Care Excellence (NICE) guidelines. METHODS Twenty-seven children with diagnosed FAP were randomized to 2 groups. Each group received an intervention: the low FODMAP diet or the diet based on NICE. All food was prepared and delivered by a catering company. Data regarding gastrointestinal symptoms were recorded by participants during the 2-week baseline assessment and 4-week dietary intervention. The frequencies of abdominal pain and stools were reported as a number of events per day. The severity of abdominal pain was assessed using the Wong-Baker FACES Pain Rating Scale. The assessment of stool consistency was based on the Bristol Stool Form Scale. RESULTS The tendency toward the improvement in abdominal symptoms was noted in the low FODMAP group but without statistical significance. No significant differences in stool consistency were observed in this group. The NICE group experienced significant reduction in abdominal pain intensity and frequency (p < 0.01) and improvement in stool consistency (93% reporting normal stool, p < 0.05). CONCLUSIONS The results of this pilot study suggest that the low FODMAP diet is not effective in the reduction of symptoms in children with FAP.
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The Effect of Oligofructose-Enriched Inulin on Faecal Bacterial Counts and Microbiota-Associated Characteristics in Celiac Disease Children Following a Gluten-Free Diet: Results of a Randomized, Placebo-Controlled Trial.
Drabińska, N, Jarocka-Cyrta, E, Markiewicz, LH, Krupa-Kozak, U
Nutrients. 2018;10(2)
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Coeliac disease (CD) is associated with changes in the gut microbiome. Prebiotics, that feed beneficial bacteria, are a promising method of restoring normal gut function in those with CD. The aim of this study was to evaluate the effect of prebiotics on the intestinal microbiota in children with CD. The researchers looked at a group of 34 children of average age 10 years. The children had all been diagnosed with CD and were following a gluten-free diet. The children were given either a supplement of oligofructose-enriched inulin or a placebo (maltodextrin) daily for 3 months. At the end of the study, Bifidobacterium count increased significantly in the group of children given the prebiotic. Faecal acetate and butyrate levels also increased in the prebiotic group, with total short-chain fatty acid levels increasing by 31% compared to the start of the study. Constipation or diarrhoea was reported by only 5% of the prebiotic group, compared to 31% of the placebo group. The authors concluded that the prebiotic supplement used in this trial had a beneficial effect on the characteristics of faecal microbiota in children with CD on a gluten-free diet.
Abstract
Celiac disease (CD) is associated with intestinal microbiota alterations. The administration of prebiotics could be a promising method of restoring gut homeostasis in CD. The aim of this study was to evaluate the effect of prolonged oligofructose-enriched inulin (Synergy 1) administration on the characteristics and metabolism of intestinal microbiota in CD children following a gluten-free diet (GFD). Thirty-four paediatric CD patients (mean age 10 years; 62% females) on a GFD were randomized into two experimental groups receiving Synergy 1 (10 g/day) or placebo (maltodextrin; 7 g/day) for 3 months. The quantitative gut microbiota characteristics and short-chain fatty acids (SCFAs) concentration were analysed. In addition, side effects were monitored. Generally, the administration of Synergy 1 in a GFD did not cause any side effects. After the intervention period, Bifidobacterium count increased significantly (p < 0.05) in the Synergy 1 group. Moreover, an increase in faecal acetate and butyrate levels was observed in the prebiotic group. Consequently, total SCFA levels were 31% higher than at the baseline. The presented trial shows that Synergy 1 applied as a supplement of a GFD had a moderate effect on the qualitative characteristics of faecal microbiota, whereas it stimulated the bacterial metabolite production in CD children.
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Food Protein-Induced Enterocolitis Syndrome.
Nowak-Węgrzyn, A, Jarocka-Cyrta, E, Moschione Castro, A
Journal of investigational allergology & clinical immunology. 2017;(1):1-18
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES.
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[Gastrointestinal abnormalities in children with autism].
Wasilewska, J, Jarocka-Cyrta, E, Kaczmarski, M
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2009;(157):40-3
Abstract
The autistic spectrum disorder (ASD) is a neurodevelopmental disorder characterized by socially aloof behavior and impairment of language and social interaction. This paper is a review of literature on gastrointestinal problems in children with ASD. Gastrointestinal symptoms are described in 9-54% of autistic children, among which most common are: constipation, diarrhea and abdominal distension. The gastro-intestinal abnormalities reported in autism include: inflammation (esophagitis, gastritis, duodenitis, enterocolitis) with or without autoimmunity, lymphoid nodular hyperplasia, increased intestinal permeability, low activities of disaccharidase enzymes, impairment of detoxification (e.g. defective sulfation of ingested phenolic amines), dysbiosis with bacterial overgrowth, food intolerance or exorphin intoxication (by opioid derived from casein and gluten). A beneficial effect of dietary intervention on behavior and cognition of some autistic children indicates a functional relationship between the alimentary tract and the central nervous system. There are no epidemiologic data concerning the incidence or prevalence of gastrointestinal problems within the population of children with ASD in comparison to the population of non-ASD children.
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[Focal villous atrophy of the duodenum in children who have outgrown cow's milk allergy. Chromoendoscopy and magnification endoscopy evaluation].
Jarocka-Cyrta, E, Baniukiewicz, A, Wasilewska, J, Pawlak, J, Kaczmarski, M
Medycyna wieku rozwojowego. 2007;(2 Pt 1):123-7
Abstract
UNLABELLED Patchy villous atrophy of duodenal mucosa has been described in young children with cow's milk allergy (CMA). Cow's milk protein-sensitive enteropathy may persist in older children and shows characteristic histological features. The advent of magnification endoscopy may allow the macroscopic detection of unrecognised villous atrophy in these patients. AIM: the aim of the study was to evaluate the duodenum mucosa in older children with CM A in infancy using chromoendoscopy and magnification endoscopy. METHODS the study involved 15 children (mean age 15 years; range 12-18) with CM A diagnosed and treated in infancy, currently on normal diet, referred to our department due to abdominal pain. The control group consisted of 8 children with abdominal pain without any evidence of allergy (mean age 15 years, range 13-18). In all patients magnification endoscopy and chromoendoscopy was performed under general anaesthesia (GIFQ 160Z, Olympus). The bulb and the descending portion of the duodenum were examined. 1% methylene blue was used for staining. Each endoscopy was recorded on DVD. Patients with celiac disease, after surgery or treated for other disorders were excluded from this part of the investigation. RESULTS seven of 15 patients with CM A in infancy had focal villous atrophy of the descending part of the duodenum. In the control group, the villous atrophy was seen in one case. CONCLUSIONS 1. Magnification endoscopy and chromoendoscopy are a valuable method of detecting focal villous atrophy in patients with suspected food allergy. 2. Focal villous atrophy may indicate the presence of food hypersensitivity of persisting from infancy process.
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Mast cells in neoangiogenesis.
Nienartowicz, A, Sobaniec-Łotowska, ME, Jarocka-Cyrta, E, Lemancewicz, D
Medical science monitor : international medical journal of experimental and clinical research. 2006;(3):RA53-6
Abstract
Mast cells (MCs) always accompany connective tissue and are located in the proximity of lymphatic and blood vessels and nerve fibers. They are round or oval mononuclear cells with a diameter of 4-20 microm containing in their cytoplasm specific exocrine granules (storing neutral proteases) enclosed by a single membrane, whose presence is regarded as an index of the MC's static state. In view of their wide distribution in the organism, they play various roles in, for example, type I hypersensitivity reactions, chronic inflammatory processes, tissue reconstruction and wound healing, and pathological pulmonary fibrosis. They also play a role in angiogenesis, both in normal conditions during tissue regeneration and in pathological neoplastic states. The microcirculation provides building and nutritional substances to cancer cells and enables cancer spread via the blood. On the other hand, a tumor with good vascularization is more prone to penetration by cytostatics, which is why angiogenesis is a very important process in the course of neoplastic disease. Many authors indicate a close association between mast cells and angiogenesis. Some substances contained in the cytoplasm of these cells are potent stimulators of angiogenesis (tryptase, heparin), while others may inhibit it (protamine, platelet factor 4), and this conditions cancer growth and the development of the metastatic process. It is not known, however, what interactions occur between stimulants and inhibitors and what the proportional involvement of particular mediators in the formation of new vessels is.